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Answers to your top 10 queries about food, drink and diabetes

Since Enjoy Food launched last year on World Diabetes Day, many of you have asked us why we say what we say on various topics and what our official position is on everything from low-carb diets, eating saturated fat to drinking alcohol – and why we recommenda healthy, balanced dietfor everyone, whether you have diabetes or not.

Our Clinical Advisor, Douglas Twenefour, answers the top 10 questions you’ve asked us. You might be in for a surprise or two…

1 Why does Diabetes UK say people can eat plenty of carbs when they raise blood glucose levels?

This is a misconception we’re trying hard to change. Diabetes UK doesn’t say that people should eat ‘plenty of carbs’ but rather we say people should eat some carbs. The amount of carbs you need depends on a number of factors – including how physically active you are, your weight and nutritional goals. It’s important to restate that the amount of carbs you eat has the biggest effect on your blood glucose levels, so be aware of portion sizes. That’s why we include the carb information on most of our recipes.

Diabetes UK communicates with a wide range of people who have, for various reasons, different levels of understanding, preferences and beliefs, so the advice we give is general – it can’t replace what your diabetes healthcare professional (HCP) says because they have access to personalised medical information about their patients.

What we say…

People with diabetes should include some carbohydrates in their diet.

Different views…

It’s clear that some people believe that you don’t need to eat any carbohydrate foods.

What we say…

Diabetes UK disagrees with this view.

The reason is that carbohydrates are our main source of glucose, which is the preferred nutrient for the brain. Carbohydrate foods also provide us with fibre, which is important for overall good health. There are specific carbohydrate-containing foods that are scientifically proven to be good for you. These include fruit and vegetables, pulses, wholegrains, some dairy, nuts and seeds. That’s why we suggest people get their carbohydrates from these foods. We encourage people to focus on the quality of the carbs they eat and give practical advice to help people to make an informed decision.

Different views...

Other people think that everyone with diabetes should be following a low-carb diet.

What we say…

Diabetes UK disagrees with this view.

There’s some evidence that people with Type 2 diabetes, who need to lose weight, can benefit from a low-carb diet. But there’s evidence that following other diets, such as the Mediterranean diet, a healthy, balanced diet, a very low-calorie (or meal replacement) diet can also be beneficial for people trying to lose weight. As there’s a lack of consistent evidence proving that any of these diets are better than the other in the long term, we believe people shouldn’t restrict themselves to one way of eating.

A healthy, balanced diet...

What we say…

Diabetes UK recommends the healthy balance approach to eating for people with diabetes for the following reasons:

There’s strong evidence that it is beneficial for good overall health. There evidence that it can help with blood glucose, blood pressure, blood fats (cholesterol), weight and risk of cardiovascular disease.

This is not to say it is the only approach but it’s the approach applies to all people with diabetes – Type 1 diabetes, Type 2 diabetes whether they are overweight or not, gestational diabetes, pregnancy with Type 1 or Type 2 diabetes, children, elderly people, as well as people without diabetes.

It’s easier to follow without the need for extra medical or dietary supervision to make sure that the person is getting all the nutrients they need; whereas, for example, following a low-carb diet may mean less fibre is eaten or someone on a meal replacement diet may need extra help to ensure the diet is nutritionally complete with vitamins and minerals.

It’s least likely to have a dramatic effect on diabetes management, for example the need for changes to medication or more blood glucose testing to avoid hypos.

What we say to healthcare professionals…

We’ve explained to healthcare professionals (HCPs) that a low-carb diet is justof the options for Type 2 diabetes. The reason for this is that it helps HCPs support people to follow the low-carb diet safely, rather than people doing it on their own. Some people could follow the low-carb diet without supervision, but we are erring on the side of caution because if you are treated with insulin and/or certain Type 2 medications, following a low-carb diet without changes to medication and regular blood testing can lead to hypos.

What we say…

There is, again, a misconception that we don’t. We say a low-carb diet isof the options for weight loss that people with Type 2 diabetes can follow, but with support. Part of the misunderstanding comes from people who believe that everyone with diabetes should follow a low-carb diet. But as there’s no consistent evidence to say that a low-carb diet is better than other diets in the long term, we can’t recommend it as the only approach for everyone with diabetes.

For people with Type 2 diabetes who have to lose weight, a low-carb diet is one of the options because there’s evidence that it works for some people. But, in the long term, what works is the approach that the person is more likely to be able to stick to – not the name of the diet or the specific food groups that they include or avoid.

That’s why we recommend that people speak to their HCP to make sure that whatever diet they decide to follow is based on evidence, and that they receive the right support to follow that diet safely.

3 What’s the evidence behind a low-carb diet? Is it right for everyone – how do people know what’s right for them?

Diabetes UK bases all our advice about food and drink on thorough reviews of research studies. We only recommend approaches to diet that have been scientifically proven to be beneficial. We look at different studies and rate the quality of each one.

What we say…

Currently, there’s very little good published research into low-carb diets for people with Type 1 diabetes. Until there are good studies looking at the practical aspects of the diet – for example, how safe it is in the long term, how it affects insulin needs and dosing, managing blood glucose and the risks of hypos – we’re not in a position to recommend it.

Different views…

Some people with Type 1 diabetes have told us that they have benefited from following a low-carb diet. There have also been some clinical audits and expert opinions to suggest that a low-carb dietbe an option for people with Type 1 diabetes. But these don’t provide us with enough evidence to base our recommendations on. That’s why we are currently not in a position to recommend it.

Low-carb diets and losing weight

The best evidence in favour of low-carb diets is for people who want to lose weight. So, if you have Type 2 diabetes, or you don’t have diabetes, and you want to lose weight, then the low-carb diet is one option. Many people follow the low-carb diet without the need for their doctor or dietitian to be involved, but we prefer that people talk to their doctor when following a low-carb diet, or any diet. This is because some people may need extra advice to make sure that they’re getting all the goodness they need. Depending on medical history and any medications taken, they may also need to take a few extra precautions such as avoiding hypos when following a low-carb diet.

What we say…

The diet you choose to follow depends on you – there’s no one-size-fits-all approach. What’s really important is to have a long-term plan for any approach you choose. That’s why we recommend that you speak to your HCP who will be able to explain the different approaches and support you to make an informed choice.

4 I thought all sugars were really bad for you?

Sugar’s a hot topic in the media but the messages are still a bit confusing. Sugar is found in a lot of foods, such as fruit and vegetables, dairy, fizzy drinks and cakes. It’s also in what we add to our drinks and foods at home.

What we say…

Sugar that’s found in whole fruits and vegetables, and milk is not a problem so you don’t need to worry about these. This is because these are healthy foods that give us other goodness such as fibre and calcium, and your body uses the naturally occurring sugars in these foods differently. But sugar that you add to your food and drink at home, and the sugar added by food manufacturers in fizzy drinks, cakes, biscuits, isn’t good for our health. (It used to be known as ‘added sugar’ but is now called ‘free’ sugar.) That’s why we encourage everyone to reduce the amount of sugar from these foods and drinks. We also encourage people to limit fruit juices and smoothies to not more than one small (150ml) glass a day.

But, rather than focusing on sugar alone, we recommend that you take a look at your whole diet – everything you eat and drink will have some affect on your diabetes management and the risk of future complications, not just your sugar consumption.

5 If you have diabetes, shouldn’t you just cut out sugar completely? Why do you say people with diabetes can have things like cakes?

Probably one of our most common queries is based around people with diabetes being told they can’t eat certain foods – from sugar to potatoes! This is simply not true – you don’t have to cut out any food group or individual foods completely. However, we say that drinks high in ‘free sugar’ such as fizzy drinks, energy drinks etc are not necessary for good health so they are better avoided.

What we say…

Food advice should be based on evidence, which must also be matched with what’s practical and achievable for people in the long term. That’s why recommendations about sugar advise us to reduce our intake rather than cut it out completely. We know we don’t need ‘free sugar’ in our diet, so the recommendation could have been to cut it out completely, but that’s not realistic – there has to be a common sense approach to recommendations. People have to be able to make healthy changes, and sustain these changes in the long-term while still enjoying what they eat and drink.

That’s why, all over the world, the recommendation is to consider foods that may be high in ‘free sugar’ just as treats. There’s no evidence that the odd small slice of cake is going to massively affect your long-term diabetes management or your overall health. You can, of course, decide to avoid treats such as chocolates, sweets and biscuits altogether, but for many people this isn’t doable. Most of us would like to feel we could still enjoy small amount of our favourite treat every now and again.

6 What about the majority of people with diabetes who are overweight – don’t carbs cause fat storage?

If you’re overweight, losing weight is the best thing you can do to manage your diabetes and reduce your risk of long-term complications. Any step to reduce your overall energy intake (ie calories), and increase your energy output (through exercise, even just walking more), will help to do this. There are many different ways to reduce your calorie intake, but there’s no consistent evidence that limiting one particular nutrient, eg carbs, fat or protein, will affect your weight for the better in the long term. Even though gram for gram fats contain more calories (9kcal/g) than carbs (4kcal/g) and proteins (4kcal/g) there’s no strong evidence to suggest that the energy from carbs affects your weight or body composition differently to the energy from fat or protein. When it comes to your weight, it is the total energy consumed that counts, more than where the calories come from.

What we say…

What’s important is reducing your overall calorie intake consistently to reap long-term benefits rather than limiting one particular nutrient or food group.

For good health, it’s important to eat good sources of carbs – fruits and veg, pulses, wholegrains, dairy, nuts and seeds – and limit the unhealthy sources – sugary drinks, biscuits, cakes, etc. Likewise, it’s important to eat good fats like olive oil, nuts, avocados, oily fish and rapeseed oil, instead of saturated fats such as lard, ghee, butter and those found in processed meat.

Losing weight is complicated and being successful in the long term often means changing you behaviour and habits around food. People who’ve successfully lost weight and maintained that loss tend to

weigh themselves regularly – mostly once a week

eat breakfast every day

reduce their intake of fast foods (eg takeaways)

reduce their portion sizes

spend less time watching TV/sitting

do extra physical activity, including walking more.

Top tip

You can also keep a food diary to track what you’re eating and use this to spot any patterns and habits that need changing.

8 What does Diabetes UK say about eating saturated fat? I read that it’s OK to eat more butter now?

There’s been a lot of debate about saturated fat and whether butter is better for us than we thought. Part of this came from a review that stated that there was very little benefit when saturated fats (like butter) are replaced. Various experts have different views, too.

This is a summary of Diabetes UK’s position:

Not all saturated fats are the same, and not all of them are bad for your health. However, different saturated fats co-exist in many foods and there is not much consistent evidence to fully understand the benefits/harmful effects of the different saturated fats in specific foods.

There’s no evidence that eating a lot of saturated fat is good for health.

There is evidence that eating too much saturated fats can increase blood cholesterol, f

There is evidence that replacing saturated fats with unsaturated fats reduces the risk of cardiovascular disease (CVD) in the general population and people who are at high risk of CVD, which includes people with diabetes.

There’s evidence that replacing saturated fat with wholegrains is good for CVD health, but replacing saturated fats with refined carbohydrates can increase the risk of CVD.

What we say…

We continue to advise people to eat foods that are proven to go hand in hand with good health. These include fruit and vegetables, wholegrains, dairy, seafood, pulses, and nuts. We also say that it’s also important to limit the amount of red and processed meat, sugar-sweetened foods, sugar-sweetened drinks and refined grains.

9 What’s your advice on drinking alcohol if you have diabetes?

The recommendation for drinking alcohol when you have diabetes is similar to that given to people without the condition (that’s 2–3 units a day for women and 3–4 units a day for men). But, depending on how your diabetes is treated, alcohol can increase the risk of your blood glucose levels dropping too low and you having a hypo. So, it’s important to monitor the effect it’s having on your blood glucose levels, avoid binge drinking and drinking on an empty stomach. As alcohol contains 7kcal/g you may also want to reduce your intake to manage your weight. There is also evidence that having alcohol in excess can affect your blood blood pressure and blood fats (cholesterol).

10 Fruits have a lot of sugar in them – can I still eat fruit if I have diabetes?

Fruit contains fibre, which is good for overall health. But it also contains carbohydrates (sugar), which affect your blood glucose levels. The sugar that is naturally intact in whole fruit does not count towards free sugar as your body uses this sugar differently. Most fruits also have a low to medium-glycaemic index (GI), so they don’t have an immediate effect on your blood glucose levels in the way other refined carbohydrate foods, like white bread, do. If you spread your intake of whole fruit throughout the day, rather than eating a huge portion in one go, there’s no reason why you can’t eat any fruit you like.

A portion of fruit is approximately what will fit in the palm of your hand. It’s easy to overdo it, though, especially if you have the whole bowl in front of you. Be careful with dried fruits – a portion is just one tablespoon. If you go for tinned fruits, choose one that’s tinned in the natural juice rather than syrup – and always read the label.

What we say…

Limit fruit juices and smoothies to a maximum of one small glass (150ml) a day, as they count towards your intake of free sugar. One small glass of 100 per cent pure fruit juice is one portion of your five a day – no matter how much of it you drink Be mindful that some smoothies and juice drinks have extra sugar added to them so read the ingredient list to be sure. Also, fruit juices and juice drinks don’t contain as much fibre as the actual fruit itself and you can easily drink too much over a short period of time. This increases the risk of raising your blood glucose levels, which isn’t good for your diabetes. In the long term, drinking too much fruit juices and smoothies can also affect your weight – again, not good news if you have diabetes. This is why it’s a good idea to eat the whole fruit.